1. Project Hand Hygiene implementing the WHO guidelines for improving hand hygiene in health care LATVIA -LITHUANIA-RUSSIA –SWEDEN Agita Melbārde-Kelmere Ruta Markevice Anna Lubimova Birgitta Lytsy Olov Aspervall Anna Hambraeus

2. Relationship between ABR and HH YearAuthorsHospital setting Major results 1994Webster et al.NICUElimination of MRSA 1995Zafar et al.Newborn nursery Control of a MRSA outbreak 2000Larson et al.MICU/NICUSignificant (85%) relative reduction of the VRE rate 2000Pittet et al.Hospital- wide Significant reduction MRSA cross- transmission rates (87%). 2004MacDonald et al. Hospital- wide Significant reduction in hospital- acquired MRSA cases (from 1.9% to 0.9%) 2005Johnson et al.Hospital- wide Significant reduction (57%) in MRSA bacteremia

3. Aim To implement WHO SAVE LIVES: Clean Your Hands to reduce HCAI and ABR. abbreviate simplify adapt

4. Multimodal interventions System change: ABHR, soap, water at patient care level Education: standard presentation of feed-back of results and adapted presentation according to results Measurements and feed-back: observation of compliance, measurement of ABHR consumption Reminders in workplace: posters Patient safety climate: Knowledge and attitudes questionnaire

5. Project design I. Preparation phase II. Baseline phase III. Intervention phase IV. Evaluation V. Reporting

6. Workshops Vilnius in December 2011 During 2012 – Riga – St Petersburg – Upsala – Stockholm - 2 During 2013 – Riga – Final workshop - in Riga in May 2013 During of the project – Teleconferences – Skype meetings

7. I. Preparation phase Development of the instruments – Wards infrastrustructure form – Hand rub consumption form – Hand hygiene observation form and instruction – Hand hygiene education level, knowledge and attitudes assessment – Time line

8. Activities Ward infra structure survey – Measure Hand Rub Consumption and Compliance to HH policy – Perform Hand hygiene education level assessment Intervention I – Measure Hand Rub Consumption and Compliance to hand hygiene policy Intervention II – Measure Hand Rub Consumption and Compliance to HH policy – Perform Hand hygiene education level, attitudes and knowledge assessment Preparation of report

9. Interventions Intervention I – Discuss with all staff in the ward the baseline results of Hand Rub Consumption, Compliance to HH policy, HH education level assessment – Educate all staff, those at night shifts included, at least one time Intervention II – Discuss with all staff in the ward the results of Hand Rub Consumption, Compliance to HH policy after intervention I – Put up posters and change every 2 weeks – Find and educate link nurses Discuss with all staff in the ward the results of Hand Rub Consumption, Compliance to HH policy, HH education level assessment after intervention II

10. Education

11. Posters WHO posters BARN posters

12. Ward infra structure 14 hospitals 38 wards – Medical - 6 – Surgical – 11 – ICU – 10 – NICU – 5 – Neonatal – 4 – Pediatric - 2 998 patient-beds Most rooms have sinks and alcoholic handrub available (except children surgery – patients safety considerations)

13. Hand hygiene observation instruction During the observation days (max a week) 10 persons are observed. For each person the compliance during an entire patient care activity (from approaching to leaving the patient) is observed and the results are recorded in the form below. Definition of hand hygiene Hand hygiene should be performed Glows should be used and changed

14. Hand hygiene observation form adapted and simplified based on WHO guideline Number of healthcare professionals surveyed for hand hygiene compliance: Before interventions – 456 After interventions - 340

15. Percent of wards where hand hygiene compliance rate increased or remained 100% and decreased or remained 0% after all interventions for various aspects of hand hygiene

16. Percent of wards where hand rub consumption increased

17. Hand hygiene education level assessment

18. What factors prevent you from performing alcoholic hand rub? CountryQ 10a (Lack of time)Q 10d (bad for my skin) Q 10f (I use gloves) Before interaction Range (median) After interaction Range (median) Before interaction Range (median) After interaction Range (median) Before interaction Range (median) After interaction Range (median) Latviand5-2nd6-0nd2-1 Lithuania1628223124 Russia58-0 (30)46-0 (19)59-0 (17)71-0 (29)37-0 (14)46-0 (4) Sweden40-3 (21)37-16 (17)4-0 (3)2-0 (0)4-0 (3)4-0 (4)

19. Conclusion Lessons learnt Interventions led to improvement of the hand hygiene Education led to improvement of the knowledge of the medical personnel

20. Conclusion Lessons learnt Feedback of the leaders of the project allowed to understand what else was needed to do for improvement of hand hygiene

21. Conclusion Lessons learnt Hand hygiene compliance rates increased, especially among physicians, but compliance rate of hand hygiene is higher among nurses before and after intervention Future suggestions Doctor and nurse should observe each other during performing manipulations Involvement of visitors/relatives to observation of hand hygiene

22. Conclusion Lessons learnt Hand rub consumption reflects compliance to hand hygiene practice Lack of time for observation of HH Additional stress of the medical personnel under observation HH Future suggestions Hand rub consumption can be used as indicator of hand hygiene compliance when time/trained personal for observation is lacking

23. Conclusion Lessons learnt Better results were received in hospitals where hospital epidemiologists were leaders of the project, worse results – where nurses from the same ward were leaders of the project Future suggestions Infection control professionals must head programs of improvement of hand hygiene

24. Conclusion Lessons learnt Easy for implementation Possibility of implementation of the experience obtained in other wards and hospitals Future suggestions Development of technical guidelines on observation of hand hygiene and hand rub consumption

25. Future suggestions To pay more attention of these aspects in educational programs

26. Future suggestions Development of bundles of implementation of HH, including “5 moments of hand hygiene” Creation of the program of distance learning programs of HH and prevention HAI

27. Forward to the Future!!!!